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KEPRO and McKesson to Share Guidance for Understanding the Two-Midnight Rule and Avoiding Denials at 2016 ACMA National Conference

Rare opportunity to gain insight into BFCC-QIO’s perspective on short-stay inpatient admissions, to help improve decisions and reduce denials

Harrisburg, PA - Executives from McKesson Health Solutions and KEPRO will share the podium at the ACMA 2016 National Conference to help providers better understand how to reduce denials, the Centers for Medicare & Medicaid Services’ (CMS) final Two-Midnight Rule and the Beneficiary and Family Centered Care audit process. Co-presenting at the conference, being held April 2-6 in Tampa, Fla., will be Tammie Phillips R.N., McKesson’s Vice President, Business Consulting, and Cheryl Cook R.N., KEPRO’s Program Director for CMS Areas 2 and 4.

“Many providers are still confused by the Two-Midnight Rule and how it relates to medical necessity and overall care management program considerations”

Their interactive session, “Denials Management, the Two-Midnight Rule, and the QIOs Perspective,” will be held on April 5th at 10:30 a.m. ET. Phillips and Cook will discuss provider trends and challenges around denials management, with particular focus on the impact of the updated rule. They will share insights on the BFCC-QIO audit process and expose common gaps in provider workflows. This is a unique opportunity to hear perspectives directly from one of only two BFCC-QIOs charged by CMS to audit short-stay claims and ask questions.

“Many providers are still confused by the Two-Midnight Rule and how it relates to medical necessity and overall care management program considerations,” Phillips says. “Knowing what to expect requires an understanding of correct documentation of medical necessity, how the QIOs will conduct the audit process and the tools they will use to support their short-stay inpatient reviews. Our session will shed light on these challenges and opportunities, which are crucial advantages for reducing denials.”

The 23rd annual American Case Management Association (ACMA) National Conference will convene over 1,500 case management and transitions of care professionals for ongoing training, education, and networking, to strengthen their skills within the practice setting. A long-time supporter of ACMA, McKesson will be exhibiting and answering attendees’ questions at ACMA booth #312.

For more information on the ACMA 2016 National Conference, visit http://casemanagementconference.com. For more information about McKesson Health Solutions, please visit www.mckesson.com and follow us on Twitter at @McKesson_MHS. For more information about KEPRO, please visit our website, ‘Like’ us on Facebook or follow us on Twitter at @KEPRO_PA

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KEPRO Awarded New Contract in Minnesota for Emergency Medical Assistance

HARRISBURG, PA – KEPRO announced today it was recently awarded a new contract with the state of Minnesota to manage the Emergency Medical Assistance Program on behalf of the Minnesota Department of Human Services.

“We’re excited to expand our services for the state of Minnesota,” said Joe Dougher, President and Chief Executive Officer. “Over the past 3 years we have worked to provide utilization management for the state’s Medicaid program and this opportunity allows us to further enhance our healthcare services for Minnesotans.”

KEPRO currently manages Minnesota’s Fee-for-Service Medicaid program and helps 315,000 members receive the quality care they need through utilization management. KEPRO’s clinical team, based in Bloomington, determines the medical necessity of various healthcare procedures, treatments, and health services, including mental health services for both children and adults, dental services, and durable medical equipment.

With the new contract, KEPRO will provide services to support the management of the Emergency Medical Assistance (EMA) program. EMA covers the care and treatment of non-citizens who would otherwise qualify for Medicaid for emergency medical conditions provided in the Emergency Department or inpatient hospital. EMA also covers some care and treatment provided in other settings without which a patient’s health would be in serious jeopardy, including dialysis and cancer treatments. KEPRO will review submitted Care Plan Certification requests to determine if individuals meet established criteria for coverage.

KEPRO, a leading quality improvement and care management organization, offers innovative and outcomes-focused solutions to reduce the utilization of health care resources and optimize quality of care for public and commercial clients. KEPRO’s tailored programs maximize members’ quality of life, and realize greater cost savings for members and clients alike. To learn more about KEPRO, visit www.KEPRO.com.

 

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KEPRO Announces Two New Executive Appointments

HARRISBURG, PA – KEPRO is pleased to announce the appointments of Meghan Harris as Executive Vice President and Michael Wolf as Vice President for Government Relations.

In addition to being the Chief Operating Officer, Harris has also been appointed as the Executive Vice President and now heads Operations, IT, Health Service Research and Quality for KEPRO. Harris is also responsible for KEPRO’s public and commercial operations, providing operational leadership to achieve company-wide goals and objectives. Harris brings nearly 17 years of experience in the health services research field, with expertise in biostatistics, experimental design, sampling, regression, health outcomes, and savings calculations.

“Meghan has been a keystone in the fabric of KEPRO and the work that we do,” said KEPRO President and CEO Joseph A.  Dougher. “We’re very excited to have her as our Executive Vice President and operational leader in achieving our goals and objectives.”

Harris earned her Bachelor of Science degree in mathematics from Malone College in Canton, Ohio; and her Master of Science degree in Statistics from the University of Akron. She is a member of the Cleveland Chapter of American Statistical Association, the American Society for Quality, and the American Health Quality Association.

In addition, KEPRO is pleased to announce that Wolf will lead public affairs and policy efforts on a national level on a variety of health care initiatives including access to care and integration of care issues in public healthcare payer programs.

“Michael‘s expertise and experience in state government will be invaluable as we grow and increase our government and commercial clients,” Dougher stated. “He will be the lead on coordinating with government entities to develop effective and cost-efficient programs for their members.”

With more than 10 years of experience in the health industry and most recently serving as the Secretary of the Pennsylvania Department of Health, Wolf will play a crucial role in developing new government partnerships and identifying innovative ways KEPRO can better serve our clients and their members through cost-saving measures.

Wolf is recognized as the leader of Pennsylvania’s State Innovation Model efforts with the Center for Medicare and Medicaid Innovation Center spearheading efforts to create greater adoption of patient-centered medical homes and greater use of technology to help address medically-underserved. Wolf will also oversee KEPRO’s Communications Office to better align KEPRO’s brand and to enhance two-way communication with clients and members.

KEPRO, a leading quality improvement and care management organization, offers innovative and outcomes-focused solutions to reduce the utilization of health care resources and optimize quality of care for public and commercial clients. KEPRO’s tailored programs maximize members’ quality of life, and realize greater cost savings for members and clients alike. To learn more about KEPRO, visit www.KEPRO.com.

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Please describe KEPRO data security that ensures member information is protected.

As an organization that is charged with storing and transferring Protected Health Information (PHI), KEPRO is bound by HIPAA regulations, and is accustomed to managing the security and privacy of PHI. KEPRO currently exchanges data successfully and confidentially via secure encrypted means in support of all of our federal, state, and local government programs, and with commercial clients.

KEPRO has been implementing and supporting systems that require medical record, data security, and transmission for more than a quarter of a century, and has always placed primary importance on using systems that allow for fast and efficient connectivity, while still providing the highest level of data and system security. Our proven internal and external policies and protocols ensure compliance with state and federal laws and regulations, as well as any additional security measures you may require.

We have a stringent KEPRO Comprehensive Confidentiality Plan that governs our processes. KEPRO’s Privacy Officer, Security Officer, and the Compliance Officer have ultimate responsibility for oversight of the processes and procedures contained in the KEPRO Comprehensive Confidentiality Plan.

KEPRO's system is secure. Our information systems are secured by an in-depth strategy that utilizes multiple layers of operational, management, and technical controls to protect KEPRO assets. We also employ software programs designed to prevent unauthorized use by staff or outside entities.

All KEPRO information systems employ common security controls such as Firewalls, Anti-virus, Role Based Access, FIPS 140-2 Encryption for mobile devices, and the requirement of strong passwords. Information system users are assigned a security role based upon access requirements relevant to their positions and information/program privileges.

The HIPAA Security Rule requires entities to implement information systems that control access to healthcare and related systems. KEPRO adopts a subset of NIST 800-53 Rev 3 Security controls to maintain compliance with HIPAA. Based on these security standards, KEPRO mitigates risk to its Information system by focusing on such controls as:

  • Log-In Security. HIPAA security requires the use of secure User IDs and the use of passwords. KEPRO requires multiple account authentication processes within its information systems to verify the identities of our end-users. KEPRO's policy requires strong passwords that are changed frequently.
  • Access Control. HIPAA requires one of the following: Context Based Access, Role Based Access, or User Based Access. User Based Access is part of the Log-In Security component. KEPRO's Role Based Access gives individual users access relevant to their function in the organization.
  • Audit Trail. HIPAA requires the use of an audit trail to identify who accesses PHI. KEPRO systems track those who change the patient record, the date and time the record was modified, and the specific information changed. The system includes a read only audit trail that captures each time a system user views a case.
  • Session Time-out. KEPRO information systems account for session inactivity by locking screens after 10 minutes of inactivity.
  • KEPRO's physical space is secure. KEPRO’s computer, telephone, and hardware systems are located in climate controlled rooms with fire-suppression and electronic locking system. We allow only authorized access to the room.
  • KEPRO focuses training on confidentiality and security issues. All KEPRO employees undergo rigorous training on security and confidentiality of PHI. We have successfully provided this training to all staff regardless of their respective roles/duties.

KEPRO Headquarters

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777 East Park Drive, Harrisburg, PA 17111
Toll-free: 800.222.0771
Phone: 717.564.8288
Fax: 717.564.3862